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Dx Neural Foraminal Stenoses Bilaterally at c5-c6
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Dx Neural Foraminal Stenoses Bilaterally at c5-c6

I have had neck pain/migrains for several years.  For the past year I have had vertigo which has gone unexplained.  ENT docs have done extensive testing and diagnosed me with vertical nystagmus, cause still unexplained.  When numbness in my arms was added to the vertigo, in addition to recent facial parasthesia, I went to my NeuroSurgeon (small periopthalmic stable brain aneurysm X 2 years) and he ordered an MRI.  Results are normal with the following exceptions:  C5-C6:  Broad based disc-osteophyte complex which does efface the anterior thecal sac.  The central canal continues to measure over 9.4 mm in transverse diameter.  There is mild to moderate bilateral neural foraminal stenosis due to uncovertebral hypertrophy, right slightly greater than left.  C6-C7:  Broad based central disc-osteophyte complex.  The central canal measures over 9.7mm in AP dimension.  No significant neural foraminal stenosis.  Conclusion:Degenerative disc disease at C5-C6 and C-6-C7.  This is more pronounced than prior study (2 years ago).  NEURAL FORAMINAL STENOSES BILATERALLY AT C5-C6.  Question:  does this explain vertigo in addition to numbness in arms and clumsiness and if so, is Physical Therapy an option for this diagnosis or is surgery required?  My Neurosurgeon has been too busy to call back and I am nervous about the outlook for this dx.  Any information or input would be appreciated.
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Avatar_f_tn
Forgot to mention bowel incontinence (5 1/2 weeks of diarrhea, overall exhaustion and extreme vertigo. ) I was convinced and told I had Gastroenteritis and was dehydrated, however bloodwork and a colonoscopy returned normal results.  I was told that it is possible that the pressure in the nerves in my neck may control bowel and bladder function.  Is it possible that this neck problem is causing my stomach problems??????
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Avatar_f_tn
Yes, it could be caused by pressure on the nerves, but C5-6 usually control arms, hands etc. It sounds like you have bone spurs pressing on the nerves. I don't think PT will help for this condition. This is only my opinion tho. I had a C-5-6 single level fusion last June, and have done quite well with it. Not inhibiting my neck movement. Mine was a disc herniation injuly, not DDD, so not sure how much difference this would make. The surgery wasn't nearly as bad as I anticipated.  Good luck, when do you see your neuro again? Please post results.
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Avatar_f_tn
Thanks for the reply!  My Neuro is being slightly difficult and their office told me that when I had my follow up on Oct 29 (over a month!) he would pull the MRI and consult with me then.  I told them I had an issue with this and needed to speak to him sooner.  Unfortunately, I am having severe pain in my face (parasthesis) and continual numbness in the arms.  It sounds like your surgery went well - but the anticipation of what he plans to do it what is making me nervous.  The PA in the office should call me back today.  More info later.  Thanks so much for the info.  Talk to you later.  P.S.  Was the surgery outpatient or inpatient and how long did your recovery take?
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Avatar_f_tn
Thanks for the reply!  My Neuro is being slightly difficult and their office told me that when I had my follow up on Oct 29 (over a month!) he would pull the MRI and consult with me then.  I told them I had an issue with this and needed to speak to him sooner.  Unfortunately, I am having severe pain in my face (parasthesis) and continual numbness in the arms.  It sounds like your surgery went well - but the anticipation of what he plans to do it what is making me nervous.  The PA in the office should call me back today.  More info later.  Thanks so much for the info.  Talk to you later.  P.S.  Was the surgery outpatient or inpatient and how long did your recovery take?
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Avatar_f_tn
It was supposed to be day surgery, but I ended staying one night in hospital due to a bad reaction to the morphine I was given for pain. With osteophytes and DDD physical therapy probably would not help much. The surgery should help a great deal. It won't cure everything, but hopefully will improve your quality of life greatly. Good luck talking to your neuro!
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Avatar_f_tn
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Avatar_f_tn
Morphine's no fun...  been there.  Halucinated.  Talked to goats and a cowboy.  Got terribly sick.  Terribly terribly sick.  I can relate.  So, I talked to the Dr today and he feels as though the neck problems are a secondary issue issue to another underlying problem and that since the spinal cord itself was not impinged that we needed to look for another explanation,  Also, it does not explain the facial pain at all.  The facial pain, he explains, comes from the brain stem area.  He thinks it may be Trigeminal Neuralgia, or tic douloureaux.  He has ordered an MRI of the brain and stem, with and without contrast (last study of brain in July was an MRA for the aneurysm and he says an MRI will better show the blood vessels in the brain/stem.  He is also ordering some test/scan/imaging of my carotid artery - which he admits is slightly out of his area of expertise and focused more towards a Cardiologist - but he wants to help me with the full spectrum of care and help figure out what's wrong.  My facial pain today was to the point of debilitating - with a feeling like my eardrum was about to explode.  Vertigo is terrible and overall sense of well-being is taking a severe beating.  The Neuro is ordering the tests STAT and asked me to call him personally as soon as they were complete for a follow up.  Scary reading about Trigeminal Neuralgia because it links with MS and with all of my symptoms, I could fit both categories.  Will see what the tests show up, I guess next week.  There must be an explanation for all of it, including the overall malaise and fatigue, muscle weakness and loss of coordination, in addition to the facial pain....  I'll keep you posted and appreciate the support and info.
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Avatar_f_tn
It sounds like you have a good, concerned doctor. That is so important.Sounds like he ordered a good spectrum of tests, maybe you will have answers soon. Please post results....I cooked French Toast for the entire roster of PBR Bullriders, even though I couldn't remember their names, and was doing it in the oven.LOL That was after I got over being nauseated so badly.Don't know what some people see in LSD!! LOL No more morphine for me
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Avatar_f_tn
Hi there.  I am going to the local hospital on Friday am for an MRI of the brain/stem and a CTA to check blood flow in the carotid artery.  The vertigo is so bad that I almost hit the floor yesterday.  Went to the ER today, and that was a total failure, so the NeuroSurgeon moved up my appointments.  I did get a rx for Anti-Vert today and seem to be tolerating the Lyrica for the Trigeminal Neuralgia fairly well, except for extreme exhaustion and double vision.....

I will post results as I get them.  I am calling the Neuro as soon as the tests are complete.  Fortunately for me, they were able to schedule them back to back.

And by the way, now I have been craving french toast!!!!
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Avatar_f_tn
I had a herniated disk at c 5-6.  The initial x ray I had showed "degenerative disk disease  c 5-6 with bilateral foraminal encroachment".  My arms and hands were numb and tingly.  Anyway, I ended up having surgery.  I'm still having problems.  I will tell you there is no way c 5-6 area affects the face.  Your facial numbness and tingling is from something else.  Also,  the c 5-6 area can affect your bladder, bowel, legs etc...If you have cord compression and cervical myelopathy.  It can affect you from that level down.
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Avatar_n_tn
I read the symptoms you have experienced with problems with c 5-6.  I'm wondering if it could cause a sore neck, arm leg and shoulder muscles pain, weakness and spasms (on and off).  My MRI was normal for neck and brain  (no contrast given), so my neuro is refusing a myologram or another MRI with contrast.  Any advise?  I am really scared...my emg test came out abnormal as well.  Still no diagnosis and I want to be sure it's not something like a compressed nerve they are missing, or a cervical disk problem.....I did fall down the stairs 3 years ago and had about a year of central back pain as a result.  That pain went away, but now I have all this going on.  I am considering the Mayo clinic if nothing is diagnosed soon....I worry about ALS.  
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Avatar_f_tn
It could cause the sore neck and arm and shoulder muscle pain,  and weakness and spasms in the upper body but would not affect the lower body unless the spinal cord is compressed causing myelopathy.  What part of your body was the EMG done?  Your brain MRI should have been done with contrast at the very least.  None of my neck MRI's were with contrast and they clearly showed my spine problems.
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Avatar_f_tn
What a drag. Neck problems aside, I went today for my MRI of the brain and stem with and without contrast, as well as a CT scan of the carotid artery (which fortunately, came out clear).  My MRI, however, shows white matter brain lesions, which are not tumors, but apparently typical of MS......
The NeuroSurgeon spent some time telling me that an atypical diagnosis would be a possible vascular disease or Lupus, but he felt fairly certain that we are looking at MS.  He admitted that he did not want to speak "out of practice" and said I needed to immediately get to a Neurologist who could properly further diagnose and treat whatever is wrong.  He said we need to get into some "deep neurology" which is impossible for him to test.  My 2006 MRI did not show any lesions, and he said there were several that have developed within the last year.  He said we are at a "Good Step-up Point" where we could treat my symptoms.  The vertigo is absolutely dibilatiting, but I refuse to give in if it is MS.  Any feedback is appreciated.....  not good news.  Definitely not what I was expecting to happen today.....  So, my advice at the moment is cherish each day for the good moments because you never know what may happen.  To hemklne, I would advise you to get to the Mayo clinic if you can.  Grab whatever it is by the horns and get it figured out.  Good medical advice seems hard to come by.  I have been fortunate, but, I say go to Mayo...
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Avatar_f_tn
I am so sorry to hear of your diagnosis, but knowing is better than not knowing. There are a lot of new treatments out there. Please go on the MS pt to pt forums here. There is a great pediatritian on there, name Of Quix or Quixotic, who has MS and Vertigo. She is so knowledgable, and able to hlp answer questions. Sometimes she isn't feeling well, so might have to wait for a reply for awhile. There are lots of great posters on there who will give you wonderful advice and support. They have been trying to help me figure out what its wrong with me! My thoughs and prayers are with you. Get to it girl! Sometimes people have to wait several years for a diagnosis, you are so lucky not to be in limbo, and can start getting the help you need. Best wishes.
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Hi, LLWB gave me the heads up to come over and see what you are going through.  You have really been through the wringer, I am so sorry to see that.  This newest development, though, certainly does explain the vertigo, weird arm numbness that may not correspond quite right to the nerves exiting the spine from C4C5, the fatigue (mind-numbing isn't it?) and increased clumsiness.  In MS, clumsiness isn't just muscle weakness, but often a miscalculation in the brain of exactly where things are and what it is going to take to reach them, grip them or step over them.  It's often a problem of spatial anaysis.  You find yourself walking into walls, missing doorways, or walking off into the bushes??  or reaching for things only to knock them over?

The Trigeminal Neuralgia (my condolences) is a well described presentation of MS, being pain in the 5th Cranial Nerve, especially (but not only) if it is bilateral. The double vision is also very common and is not really the vertigo usually, but another problem with cranial nerves (III, IV or VI) that control the movements of the eyes to keep them exactly focused on the same spot.

Most of your DDD is seen in foraminal stenosis in the cervical spine.  This WOULD NOT cause your bladder/bowel issues, but would more likely be involved in pain, numbness, weakness of the arms alone.

It is common to see MS superimposed upon DDD probably because DDD is so common and MS is the most common neuro disease of young and middle-aged adults.

I hang out as the resident medical person - unofficially - over on the MS Forum.  I am a retired, disabled pediatrician who left medicine in 2001 after 23 years in practice.  I was first disabled by Autoimmune Vertigo (so I totally - totally - understand how debilitating, fatiguing and mentally exhausting vertigo is.)  Then, in 2004, began having other neuro symptoms, and this last spring was diagnosed with MS at 55.   One of our specialties over there is helping a person with the process of nailing down the diagnosis of MS and understanding what all the stuff means.

Right now I would expect you are reeling from this new possibility.  We have several others over in the Patient-to-Patient Multiple Sclerosis Forum in exactly your position, back problems confounding the picture and newly seen lesions.  I invite you over to tell us your story and join our family.  We actually have a good time and have several dozen great people to draw info from.

Quix
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Avatar_f_tn
Many thanks to you and to LLWB.  I admit that you are correct and as opposed to the problems in the neck (I'll deal with those as a side issue, and if possible try to get help either through acupuncture or chiropractic care if appropriate.  Right now, my biggest concern is most definitely the uncontrollable vertigo (which I read is a side effect associated with MS) and the fact that I have what is described as rapidly developing or developed white matter lesions (nothing on the MRI one year ago).  I have assumed all along that the vertigo had something to do with the ear or neck, but obviously that is not the case.  The trigeminal neuralgia is a daily problem and lands me on the floor crying uncontrollably.  Vertigo on top of this is just about putting me out of commission and I am a single mother of a 7 year old that desperately relies on me to take care of him and drive him to school, etc.  With no support network where I am living (away from family) - I feel as though my life is crumbling before my eyes.  I despise driving because sometimes I get a vertigo episode during driving.  I have a question.  Aside from an MRI, what tests are out there to help determine a proper diagnosis for MS or whatever this may be???  Anticipation and anxiety have the best of me at the moment.  I am fortunate enough to have gotten my appointment with a very good Neurologist tomorrow at 1pm.  I am hoping for a definitive answer (to calm my nerves) but am also anticipating him to tell me that we will need to schedule this test and that test.....I honestly don't know how much longer I can function in my condition and am anxious over a diagnosis.  Can you tell me please how you help nail down a diagnosis?

I really appreciate the information about the other forum and am about to go take a look.  I really think the neck problems are absolutely secondary to an underlying neurological condition.  Thanks for the info and I look forward to further discussion.  Sorry to hear about your problems.  Vertigo is awful and until you experience it for yourself, there is no possible way to have someone understand the uncontrollable, reeling experience and the accompanying nausea.  With that said, I very much appreciate your input and in the meantime wish you well.  How do you control your vertigo?  The doc gave me anti-vert, but it simply knocks me out and that's totally unacceptable given my situation.
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I was reading from the bottom to the top and did not see your remarks.  Thanks so much for sending QUIX my way.  I am scared, sick, tired, dizzy and in pain.  I need help, but it's on the way.  I will post the Neuro's remarks tomorrow and in the meantime, visit the forum you both are speaking of.  I am sorry that YOU are having such a hard time.  I wish I could give some good advice, but unfortunately I don't have any knowledge to share.  I appreciate the prayers and know that you, as well as Quix are now in mine.  Talk to you soon.  In the meantime, take care.....
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Avatar_f_tn
By the way, with regard to the vertigo, I actually bump into doorways and hit walls, leaving some not so nice black and blues, so from what I hear you saying, you can relate.  How do you handle that?  Feeling like you're on a boat ride (let's go positive and make it a CRUISE;) and not being able to catch yourself.  I am anticipating a fall to the floor any day now, as I have been for the last week or so.  The first seven weeks were awful and I was running into everything.  Since last week I find my legs actually buckling underneath me and the feeling that I am about to go down really hard... Maybe I should start wearing a helmet???  Ok, just trying to find some humor in a very grim situation.  Thanks again.
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Avatar_n_tn
All of you need to realize doctors are really out of touch with their patients and are merely concerned about how much and when they will get paid for their "services" rendered.  I am now enduring my third back surgery and have come to realize that most ALL docs are in it for the money.  Heaven forbid you should have side effects such as dizziness, numbness, weakness, unexplained loss of bladder control as the surgeon will immediately refer you out to some other specialist.  Quite a few people talk about our medical system being broken.  What's broken is the doctor(s) refusing to take responsibility for their work and lack of education.  I just had my third back surgery - cervical fusion at C4,5 and C5,6 with complications.  This is a workers compensation claim and the lack of consideration/compassion from all parties involved is truly disheartening.  Then the doctors get all upset when suddenly there is an attorney involved.  Doctors are worse than used car salespeople.

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Avatar_n_tn
Question is, Are  Doctors worse  than used car salesman ?No, acourse not; Policians maybe, Here,s the deal,There,s only a few good doctors out there,many move on to a better deal because of paper work etc,If you find a good doctor you may have him or her for ten years if lucky .Go to mayo clinic, also U of minn clinics;Watch out for people who want you to have surgery;;;;; Get different ideas from other doc,s,I had two back surgerys,a couple knee,s hand rebuilt,fusion in there somewhere;Don,t let anybody put the knife to you ,unless it gets bad,Keep moving around and find a good doctor;
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Avatar_m_tn
my doctor which is suppose to be on my side don't care a bit what I am going through with my situation, I tried to get him to take my comp case after I was through with my comp doctors, he said the money wasnt there, so that tells you where he is coming from
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